Contributions
Abstract: PB1541
Type: Publication Only
Session title: Enzymopathies, membranopathies and other anemias
Background
Hemolytic anaemia and pneumonia are uncommon complications of pregnancy.Most common aetiological agents of pneumonia in pregnancy are typical bacterial pathogens,like Streptococcus pneumoniae,Haemophilus influenzae and atypical bacterial pathogens,like Mycoplasma pneumoniae,Chlamydia pneumoniae and Legionella pneumophilia.
Aims
Unfortunately,the incidence of Mycoplasma pneumonia in pregnant women and the probability of spontaneous abortion is unknown.Also,the association between risk for abortion in patients complicated by secondary autoimmune hemolytic anaemia is yet to be established.
Methods
A 31 year old woman,with no known comorbidities in the past,G2P1L1A0,at 12 weeks period of gestation,presented with fever,cough and breathlessness for 2 weeks.Upon physical examination,patient appeared ill,dyspnoeic,with significant pallor and icterus,had bilateral basal crepitations and 12-14 weeks relaxed uterus.Initial investigation reports revealed anaemia,indirect hyperbilirubinemia,elevated LDH and reticulocyte count,and,single live intrauterine gestation 11 weeks 4 days on USG abdomen.
Results
Positive direct coombs test,high cold agglutinin titer with anti-I specificity and peripheral smear examination(figure1)showing agglutination of RBCs with normal platelets,increased number of WBCs without immature cells,pointed towards immune hemolytic anaemia,suggestive of cold agglutinin disease.Bone marrow biopsy was not indicative of any hematological malignancy.Though steroids,blood transfusion(O negative)and antibiotics were initiated,she developed bleeding per vagina and products of conception expelled with fetus.Acute hemolysis complicating Mycoplasma pneumoniae infection seemed the most likely diagnosis,which was confirmed serologically with positive antimycoplasma IgM and high antibody titer by complement fixation.Chest X-ray showed high-density area in right lower lobe.Azithromycin was given along with steroids.Patient improved and she remains clinically well,with no recurrence of jaundice
Conclusion
We report a unique case of Mycoplasma pneumonia complicating pregnancy,resulting in spontaneous abortion and secondary autoimmune hemolytic anaemia.Though pneumonia in pregnancy can cause severe maternal morbidity and mortality,Mycoplasma pneumonia causing spontaneous abortion isn't a common clinical scenario.Moreover,our patient had severe hemolytic anaemia to such extent that cross matching for blood transfusion was not possible due to autoagglutination.There have been many instances where autoimmune hemolytic anaemias are not evaluated for any secondary causes.This could leave an asymptomatic infection or hematologic malignancy undetected unless progressed to an advanced stage.The infrequency with which it is encountered makes it a formidable diagnostic challenge.We emphasize the need for further studies on association,if any,between the risk of spontaneous abortion in Mycoplasma pneumoniae complicated by secondary autoimmune hemolytic anaemia.
Keyword(s):
Abstract: PB1541
Type: Publication Only
Session title: Enzymopathies, membranopathies and other anemias
Background
Hemolytic anaemia and pneumonia are uncommon complications of pregnancy.Most common aetiological agents of pneumonia in pregnancy are typical bacterial pathogens,like Streptococcus pneumoniae,Haemophilus influenzae and atypical bacterial pathogens,like Mycoplasma pneumoniae,Chlamydia pneumoniae and Legionella pneumophilia.
Aims
Unfortunately,the incidence of Mycoplasma pneumonia in pregnant women and the probability of spontaneous abortion is unknown.Also,the association between risk for abortion in patients complicated by secondary autoimmune hemolytic anaemia is yet to be established.
Methods
A 31 year old woman,with no known comorbidities in the past,G2P1L1A0,at 12 weeks period of gestation,presented with fever,cough and breathlessness for 2 weeks.Upon physical examination,patient appeared ill,dyspnoeic,with significant pallor and icterus,had bilateral basal crepitations and 12-14 weeks relaxed uterus.Initial investigation reports revealed anaemia,indirect hyperbilirubinemia,elevated LDH and reticulocyte count,and,single live intrauterine gestation 11 weeks 4 days on USG abdomen.
Results
Positive direct coombs test,high cold agglutinin titer with anti-I specificity and peripheral smear examination(figure1)showing agglutination of RBCs with normal platelets,increased number of WBCs without immature cells,pointed towards immune hemolytic anaemia,suggestive of cold agglutinin disease.Bone marrow biopsy was not indicative of any hematological malignancy.Though steroids,blood transfusion(O negative)and antibiotics were initiated,she developed bleeding per vagina and products of conception expelled with fetus.Acute hemolysis complicating Mycoplasma pneumoniae infection seemed the most likely diagnosis,which was confirmed serologically with positive antimycoplasma IgM and high antibody titer by complement fixation.Chest X-ray showed high-density area in right lower lobe.Azithromycin was given along with steroids.Patient improved and she remains clinically well,with no recurrence of jaundice
Conclusion
We report a unique case of Mycoplasma pneumonia complicating pregnancy,resulting in spontaneous abortion and secondary autoimmune hemolytic anaemia.Though pneumonia in pregnancy can cause severe maternal morbidity and mortality,Mycoplasma pneumonia causing spontaneous abortion isn't a common clinical scenario.Moreover,our patient had severe hemolytic anaemia to such extent that cross matching for blood transfusion was not possible due to autoagglutination.There have been many instances where autoimmune hemolytic anaemias are not evaluated for any secondary causes.This could leave an asymptomatic infection or hematologic malignancy undetected unless progressed to an advanced stage.The infrequency with which it is encountered makes it a formidable diagnostic challenge.We emphasize the need for further studies on association,if any,between the risk of spontaneous abortion in Mycoplasma pneumoniae complicated by secondary autoimmune hemolytic anaemia.
Keyword(s):